CALIFORNIA STATE UNIVERSITY, LONG BEACH
SCHOOL OF SOCIAL WORK
USE OF AGENCY OF EMPLOYMENT AS AN INTERNSHIP SITE
(Due to Mike foster (CYF) or Saana Polk (OAF) no later than December 18, 2013)
Students who are employed in social work agencies may request that their agency be evaluated for suitability as a field internship site for their second year field placement. The following criteria must be met:
(1) The agency must be able to provide experiences for the student during internship hours that are significantly different from normal work activities and duties.
(2) There must be a qualified field instructor available who is different from the work supervisor of the student. The field instructor must possess a MSW from an accredited school of social work, and have at least two years of post-MSW experience. The field instructor must attend (or have completed) the field instructor training.
(3) The assignments proposed for the internship must be educationally focused and meet the criteria designated by the School of Social Work at CSULB.
(4) A written proposal describing the differentiation between employment activities internship activities must be developed and signed by the student, current employment supervisor, and the proposed field instructor.
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(5) Assigned hours for field placement must be completed in a different program area or unit of the agency, allowing for an actual physical separation of employment and internship activities.
(6) Specific hours and/or blocks of time shall be designated as internship hours. A total of 16 hours per week of internship is required. Students must complete one 8 hour day; the additional 8 hours may be completed in two four hour blocks of time. A total of 500 hours of internship must be completed for the Academic Year.
(7) Agency support of the plan at all appropriate levels will be evidenced by the signed proposal and Field Work Agreement.
Some agencies have already been approved to be a field placement site, having successfully established this model in previous years. Existing agencies have a formal agreement (Affiliation Agreement) between the agency and the University, which is required for traditional off-campus internships. If the agency of employment is not an existing agency, the appropriate agency administrator may request that such an agreement be established. (Please make sure that the agency administrator signs at the end of this proposal.)
If the student is employed in an agency that already has a program in place, the student must contact the Training Coordinator and indicate an interest in completing a field internship in that agency. All students must complete a Proposal to Utilize Agency of Employment as a Field Placement Site, using the following procedures:
(1) Discuss the proposal with your agency supervisor and administration, including the basic requirements that must be met.
(2) Complete the Proposal to Utilize Employment Agency for Field Placement form. The form must contain the following information:
a. Description of current job assignment and current job duties and responsibilities.
b. Name of current employment supervisor.
c. Description of proposed internship assignment including specific client population, program area, and learning experiences that the setting would provide.
d. Name of proposed field instructor.
e. Statement describing the proposed schedule for internship activities, i.e., which days are being designated as internship assignment days and which days are designated as employment days.
f. Signatures of the student, supervisor, and proposed field instructor must be on the proposal.
(3) Submit completed form by December 18, 2013 to your Concentration Coordinator: Mike Foster – CYF, Saana Polk – OAF.
(4) Develop an alternative plan for the completion of internship hours in the event that the proposal is not acceptable and/or does not meet educational requirements.
CALIFORNIA STATE UNIVERSITY, LONG BEACH
SCHOOL OF SOCIAL WORK
PROPOSAL FOR UTILIZATION OF EMPLOYMENT AGENCY AS FIELD PLACEMENT Academic Year 2014 - 2015
MUST BE SUBMITTED BY DECEMBER 18, 2013
Name
Address
Phone(s) ( ) - ( ) -
Program Model 2-YEAR 3-YEAR
Concentration CYF OAF
Agency of Employment
Address
Phone ( ) - # Yrs Employed at Agency
DESCRIPTION OF CURRENT WORK ASSIGNMENT/DUTIES
NAME OF CURRENT SUPERVISOR PHONE
DESCRIPTION OF PROPOSED FIELD INTERNSHIP ACTIVITIES/RESPONSIBILITIES
NAME OF PROPOSED FIELD INSTRUCTOR
YEAR M.S.W. RECEIVED SCHOOL
PHONE ( ) - EXTENSION
ADDRESS (IF DIFFERENT FROM ABOVE)
CITY ZIP
DESCRIBE HOW YOUR FIELD INTERNSHIP ACTIVITIES WILL BE SIGNIFICANTLY DIFFERENT FROM YOUR EMPLOYMENT RESPONSIBILITIES:
DESCRIBE PROPOSED SCHEDULE FOR INTERNSHIP HOURS AND EMPLOYMENT HOURS
Signature of Student Date Signature of Current Supervisor Date
Signature of Proposed Field Instructor Date
Will the agency sign an Affiliation Agreement with CSULB if one does not already exist?
Yes___ No___
Agency Administrator Date
REVIEWED AND APPROVED BY CSULB SCHOOL OF SOCIAL WORK
Signature of Director of Field Education Date
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